Severe tears & pelvic floor injury
Sex Hurts Since the Birth: Painful Sex After Tears, Episiotomy and Pelvic Floor Injury
The short answer
Painful sex after birth is very common at first. An Australian study of more than 1,000 women found that 86% had pain the first time they had sex after birth. But for about one in five, it was still painful 18 months later. Ongoing pain can come from a tear or episiotomy that healed badly, tight scar tissue, pelvic floor muscle injury or spasm, prolapse, or hormonal changes. Most causes can be treated. Where the pain stems from a poorly repaired or missed tear, or a birth injury caused by substandard care, the loss of a normal sex life can form part of a compensation claim.
The loss nobody asks about.
At the six-week check, someone asked whether you were "back to normal". You said yes, because what else do you say?
But the first time you tried, it hurt so much you had to stop. Maybe it felt like tearing, or burning, or pressing against something that shouldn't be there. Maybe it still hurts every time, months later, and you've started avoiding intimacy altogether.
Maybe you feel guilty towards your partner. Maybe they're patient, and that somehow makes it worse. Maybe you grieve the easy closeness you used to have.
Painful sex after birth is a real injury, with real causes. It's not something you have to quietly endure.
How common it is, and how long it lasts
An Australian cohort study published in Midwifery followed more than 1,100 women after birth. It found that painful sex was very common, and persisted for many:
| Time after birth | Women with painful sex |
|---|---|
| First time after birth | About 86% |
| 3 months | About 45% |
| 18 months | About 23%, roughly one in five |
Around one in ten of the women with pain at each stage described it as distressing, horrible or excruciating. So if you're still in pain well after the first few months, you're far from alone, and it's worth investigating.
What causes painful sex after birth
A tear or episiotomy that healed badly.
If the tissue wasn't brought back together properly, or the wound broke down, it can heal with a tight band, a ridge, a narrowed opening, or sensitive scar tissue. The Royal Hospital for Women's perineal trauma guideline lists significant pain and disfigurement as reasons a second repair may be needed.
A severe tear.
Third and fourth degree tears involve the muscles around the back passage, and can affect the whole perineum. See severe perineal tears.
Pelvic floor muscle injury or spasm.
After a traumatic birth, pelvic floor muscles can tighten protectively and stay tight, which causes pain on penetration. Healthdirect describes how pelvic floor muscles tightening without your control can make sex painful, and lists injury from childbirth among the causes. Other women have the opposite problem: muscles torn or weakened, as in levator avulsion, which can change sensation.
Prolapse.
Queensland Health lists pain during or after sex, or reduced sensation, among the signs of prolapse. See prolapse after a forceps birth.
Hormonal changes.
Low oestrogen while breastfeeding can cause vaginal dryness and soreness. Jean Hailes notes that hormonal changes after childbirth can cause dryness, and that seeking help early improves treatment options. This cause is usually temporary and treatable, but it can sit on top of an injury, so both may need attention.
Fear and trauma.
After a frightening birth, the body can brace against anything that brings back that pain. That's not "all in your head". It's a real, physical response, and it responds to the right support.
If this is landing for you, and you've never told anyone how much this has affected you, I'd be glad to listen, with care and complete discretion.
Getting help
- Tell your GP specifically that sex is painful, and ask them to examine you, not just reassure you
- Ask for a referral to a gynaecologist, urogynaecologist or hospital perineal clinic if the pain is ongoing
- See a pelvic health physiotherapist. They can help with scar tissue, muscle tension, desensitisation and graded return to intimacy
- Ask about local oestrogen if you're breastfeeding and dryness is part of the problem
- Ask about corrective surgery if your perineum healed badly
- Consider psychological support, individually or as a couple
The Australian Physiotherapy Association's position statement on physical birth trauma describes the role of pelvic health physiotherapy in recovery after birth injury.
The effect on your relationship
Painful sex rarely stays only physical. Many women describe distance, guilt, misunderstanding and grief in their relationships. Research by Birth Trauma Australia, reported by AAP, found birth injuries can cause painful sex and relationship strain, alongside other physical and mental health effects.
Amy Dawes, co-founder of the Australasian Birth Trauma Association, wrote in O&G Magazine about how often women are told their symptoms are just their new normal, even when those symptoms are reshaping their lives.
Support can help. PANDA (1300 726 306) supports both mothers and partners. The Gidget Foundation offers free counselling for new parents.
When it may form part of a claim
Painful sex on its own isn't proof that anyone was negligent. But it may be part of a claim if it stems from a birth injury caused by care that fell short. For example:
- a tear that was missed or poorly repaired
- a pelvic floor injury after forceps you weren't warned about
- symptoms that were dismissed for months, delaying treatment
In a claim, the loss of a normal sex life is part of the pain and suffering assessment, which recognises the effect of the injury on your enjoyment of life. Treatment costs, such as physiotherapy, counselling and corrective surgery, can also be claimed. My articles on what a pelvic floor injury claim can cover and severe pelvic floor damage explain more.
Frequently asked questions
How long does sex hurt after giving birth?
For many women, pain eases over the first few months. But Australian research found about one in five women still had painful sex at 18 months. Ongoing pain is worth investigating.
Can a badly healed tear make sex painful?
Yes. A tear or episiotomy that healed with tight scar tissue, a ridge, or a narrowed opening can cause pain. It can often be treated, sometimes with corrective surgery.
Can I claim compensation for painful sex after birth?
The loss of a normal sex life can form part of a claim, if it stems from a birth injury caused by care that fell short. It's assessed as part of pain and suffering, alongside treatment costs.
Is there a time limit?
Yes. Time limits often run from when you knew, or ought to have known, about the injury and its cause. Please get advice early.
A closing thought
Intimacy is part of your wellbeing, your relationship, and your sense of yourself. Losing it is a real loss, even if few people ask about it.
So here's a gentle question: if this could be treated, what would you want your life to feel like again?
Keep reading: Maternal birth injuries: what we must talk about · Birth trauma and obstetric negligence
This article is general information only. It is not medical or legal advice, and it doesn't replace advice from your own doctor, midwife or physiotherapist. Reading it does not create a lawyer–client relationship. If you are in crisis, please call Lifeline on 13 11 14 or 000 in an emergency.
